Conditions of the Elbow, Wrist, and Hand

Question 1

What is a Monteggia fracture dislocation?

Answer 1

• a fractured shaft of the ulna with subsequent dislocation of the radial head

Question 2

What is a Galeazzi fracture dislocation?

Answer 2

• a fractured distal radius with subsequent dislocation of the distal radioulnar joint

Question 3

What are some common sites of referred pain that radiate to the upper limb?

Answer 3

• cervical spine, upper thoracic spine, myofascial conditions, rotator cuff

Question 4

What is extensor tendinopathy?

Answer 4

• “tennis elbow”
• major cause of lateral elbow pain
• due to repetitive wrist extension and pronation
• tendinopathy occurs distal to the lateral epicondyle; pain with wrist flexion that worsens with pronation and radial deviation

Question 5

What is flexor/pronator tendinopathy?

Answer 5

• “golfer’s elbow”
• major cause of medial elbow pain (but less common than extensor tendinopathy)
• due to repetitive wrist flexion

Question 6

What are some major causes of anterior elbow pain? Of posterior elbow pain?

Answer 6

• anterior: biceps tendinopathy/rupture

- posterior: triceps tendinopathy, olecranon bursitis

Question 7

What is the most common ED fracture of all age groups? What’s the mechanism of injury?

Answer 7

• distal radial fractures (wrist fractures)
• mechanism: FOOSH (fall on outstretched hand)
• (greenstick fractures result in children)

Question 8

What is a Colles’ fracture?

Answer 8

• a fracture of the distal radius with volar angulation
• mechanism: FOOSH
• look for the classic “dinner fork” deformity

Question 9

What is a Smith’s fracture?

Answer 9

• a “reverse Colles’ fracture”

- mechanism: falling on the dorsum of hand

Question 10

What is the most common carpal fracture?

Answer 10

• scaphoid fracture (75%)
• mechanism: FOOSH
• patient has lateral wrist pain with a swollen and tender snuff box
• commonly disrupts the blood supply

Question 11

What is carpal tunnel syndrome?

Answer 11

• compression of the median nerve in the carpal tunnel

- burning pain, often at rest or at night, numbness in median nerve distribution

Question 12

What is De Quervain’s tenosynovitis?

Answer 12

• a synovial inflammation of the abductor pollicis longus and extensor pollicis brevis
• common in racket sports, golf, bowling
• swelling, tenderness, crepitus

Question 13

What percent of hand fractures require ORIF?

Answer 13

• (open reduction and internal fixaton)

- nearly 100% require ORIF; treatment and rehab of hand injuries are VERY important

Question 14

What is the main mechanism of injury for thumb fractures? Metacarpal fractures? Proximal phalanges? Distal phalanges?

Answer 14

• thumb: abduction force or fall on thumb
• metacarpal: punching (boxers), falls
• proximal phalanges (more common than distal): ?
• distal phalanges: due to a crush injury

Question 15

What is mallet finger?

Answer 15

• an avulsion of the extensor mechanism for a finger

- usually due to a ball hitting the tip of a finger

Question 16

What is skier’s thumb?

Answer 16

• a torn ulnar collateral ligament due to abduction and/or hyperextension of the thumb

Question 17

What is Jersey finger?

Answer 17

• an FDP avulsion of the ring finger (ring finger is most commonly involved in FDP avulsions)

Question 18

What is the major complication of hand and finger lacerations?

Answer 18

• infections!
• these are often associated with punching someone’s mouth and getting cut at the MCPJ by the teeth; these nearly ALWAYS go bad